Characteristics of Earlier Versus Delayed Presentation of Very Late Drug-Eluting Stent Thrombosis: An Optical Coherence Tomographic Study
- Affiliated Author(s)
- 허승호
- Alternative Author(s)
- Hur, Seung Ho
- Journal Title
- Journal of the American Heart Association
- ISSN
- 2047-9980
- Issued Date
- 2017
- Keyword
- coronary artery disease; drug-eluting stent; optical coherence tomography
- Abstract
- Background-—The pathophysiology underlying very late drug-eluting stent (DES) thrombosis is not sufficiently understood. Using
optical coherence tomography, we investigated characteristics of very late stent thrombosis (VLST) according to different onset times.
Methods and Results-—A total of 98 patients from 10 South Korean hospitals who underwent optical coherence tomography for
evaluation of very late DES thrombosis were retrospectively included in analyses. VLST occurred at a median of 55.1 months after
DES implantation. All patients were divided into 2 equal groups of earlier versus delayed presentation of VLST, according to median
onset time. In total, 27 patients were treated with next-generation DES and 71 with first-generation DES. Based on optical
coherence tomography findings at thrombotic sites, main VLST mechanisms were as follows, in descending order:
neoatherosclerosis (34.7%), stent malapposition (33.7%), and uncovered struts without stent malapposition or evagination
(24.5%). Compared with patients with earlier VLST, patients with delayed VLST had lower frequency of uncovered struts without
stent malapposition or evagination (34.7% versus 14.3%, respectively; P=0.019). Conversely, the frequency of neoatherosclerosis
was higher in patients with delayed versus earlier VLST (44.9% versus 24.5%, respectively; P=0.034). The frequency of stent
malapposition was not different between patients with earlier and delayed VLST (34.7% versus 32.7%, respectively; P=0.831). The
frequency of stent malapposition, evagination, and uncovered struts was still half of delayed VLST.
Conclusions-—The pathological mechanisms of very late DES thrombosis changed over time. Delayed neointimal healing remained
a substantial substrate for VLST, even long after DES implantation.
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